While pundits and political party operatives are busily discussing the "meaning" of Tuesday's elections, here's what it means for Pennsylvania's children and their health care: the federal Affordable Care Act (ACA) is here to stay, and it's time for Pennsylvania's leaders to step up and make the most of health care reform to reach the commonwealth's 153,000 uninsured children.

For months, Pennsylvania Partnerships for Children has urged the administration and legislature to begin work on creating Pennsylvania's health insurance exchange - a comprehensive, online marketplace that allows families to explore and compare health insurance options and purchase the best coverage for their children. Under the ACA, states need to set up their own exchanges, have the federal government step in and do it for them, or choose a "partnership exchange" option that allows the federal government to run the exchange with the state retaining control in certain key areas.

Our reasoning behind the need for Pennsylvania's direct involvement in an exchange was straightforward: No one understands the unique dynamics of Pennsylvania's health insurance marketplace better than Pennsylvanians, so why should Harrisburg punt such an important task to Washington, D.C.?

First, state policymakers delayed work on an exchange because of the pending U.S. Supreme Court decision on the ACA – a decision that ultimately upheld the law and the need for exchanges. Then, state officials chose to stall until after the Nov. 6 election – an election that left Washington's power structure unchanged, meaning the ACA will remain intact.

So the clock is still ticking and time is quickly running out. Next Friday, Nov. 16, is the deadline for Pennsylvania to submit a blueprint to the federal government for operating a state-run exchange or a partnership exchange in conjunction with the federal government.

That means Pennsylvania has a week left to act.

What happens if we don't? Pennsylvania will still have an exchange in 2014, but it will be one set up and operated entirely by the federal government on Pennsylvania's behalf. In other words, the valuable knowledge of Pennsylvanians will be lost.

That's not good for our kids, and it's not good for our commonwealth.

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